Top questions about MGD treatment options answered

January 2, 2020
Cynthia Matossian, MD, FACS, ABES

For patients with meibomian gland disfunction (MGD), the LipiFlow thermal pulsation system allows physicians to treat patients in office with confidence and efficiency.

Here are some of the questions I am most often asked about LipiFlow by colleagues.

Previously by Dr. Matossian: Everything you knew about astigmatism and dry eye is wrongAre these glands too far gone?
It is ideal to treat early in the progression of MGD, in order to preserve stressed but still-working meibomian glands. But what if a patient presents with advanced gland atrophy or dropout?

Is it still worth trying to treat with thermal pulsation therapy?
This is a question I am often asked by colleagues in the hallway at conferences. In my clinical experience, it is still worthwhile treating if there are even a few functioning meibomian glands remaining.

The treatment may be able to help maintain the function of those glands or even restore more glands to functioning status. It was previously thought that gland atrophy is permanent, but Alice Epitropoulos, MD, and Arjun Hura, MD, recently presented a new way to evaluate the meibomian glands using dynamic meibomian imaging.1 Related: Addressing common thermal pulsation questionsWill thermal pulsation replace other therapies?
The short answer is no. In most cases, patients should stay on immunomodulators and continue lid health and hygiene measures such as nutritional supplements and warm compresses (I prefer a heated moisture eye mask to wash warm cloths). These are adjunctive and can help extend the efficacy of the LipiFlow treatment, in my experience.

And for patients with advanced disease, you may want to consider adding more treatments, not fewer, because the etiology of these cases is generally multifactorial. For those with severe blepharitis, I like to do a microblepharoexfoliation (Blephex) just before thermal pulsation, to get rid of the external biofilm before heating and extracting the meibum. 

Read more by Dr. Matossian 

References:

1. Hura A, Epitropoulos A, Czyz C, et al. The potential effect of LipiFlow on meibomian gland structure: A preliminary analysis utilizing dynamic meibomian imaging. ARVO Poster 935 –B0113, 2018.

 

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